Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2021; 9(16): 3943-3950
Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.3943
Diagnosis and spontaneous healing of asymptomatic renal allograft extra-renal pseudo-aneurysm: A case report
Rui-Fang Xu, En-Hui He, Zhan-Xiong Yi, Li Li, Jun Lin, Lin-Xue Qian
Rui-Fang Xu, En-Hui He, Zhan-Xiong Yi, Li Li, Lin-Xue Qian, Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Jun Lin, Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Xu RF performed the ultrasonography examinations for the patient and contributed to manuscript drafting; He EH conducted the ultrasonography; Yi ZX and Li L analyzed the computed tomography images; Lin J was the patient’s surgeon; Qian LX was responsible for revision of the manuscript; All authors issued final approval for the version to be submitted.
Supported by the Funding from Beijing Municipal Administration of Hospitals’ Ascent Plan, No. DFL 20180102; and the Capital's Funds for Health Improvement and Research, No. 2020-4-20211.
Informed consent statement: Informed consent was obtained from the patient in the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lin-Xue Qian, DPhil, PhD, Chief Doctor, Director, Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing 100050, China. qianlinxue@outlook.com
Received: November 18, 2020
Peer-review started: November 18, 2020
First decision: December 30, 2020
Revised: January 9, 2021
Accepted: February 10, 2021
Article in press: February 10, 2021
Published online: June 6, 2021
Processing time: 176 Days and 17.8 Hours
Abstract
BACKGROUND

Transplant renal artery stenosis is a relatively frequent vascular complication after transplantation. However, extra-renal pseudo-aneurysms (EPSAs) are rare after transplantation; they can be life-threatening and usually need open surgical repair. We discuss the diagnosis and spontaneous healing of an asymptomatic renal allograft EPSA caused by renal artery anastomotic stenosis, which was diagnosed in a timely manner and managed by conservative treatments.

CASE SUMMARY

We present a 37-year-old male patient diagnosed with a renal allograft EPSA caused by renal artery anastomotic stenosis due to multiple atherosclerotic plaques with ultrasonographic examination 6 mo post transplantation. The stenosis rate of 90% and the EPSA were verified by computed tomography angiography. The diagnosis was further confirmed with digital subtraction angiography. Percutaneous transluminal angiography was conducted, and a metallic stent was successfully implanted at the stenosed site of the main renal artery trunk. No further intervention for the EPSA was undertaken due to the difficulty of stenting and the risk of bleeding; regular ultrasonographic follow-ups were recommended. The stenosis was significantly relieved immediately after stent implantation and the EPSA was healed spontaneously by completely filling with hypo-echoic thrombosis 8 mo after stenting.

CONCLUSION

Ultrasonography combined with a high-frequency linear probe can detect vascular complications post renal transplantation at an early stage and improve prognosis.

Keywords: Renal transplantation; Renal artery stenosis; Pseudo-aneurysm; Ultrasonography; Vascular complications; Case report

Core Tip: Extra-renal pseudo-aneurysms (EPSAs) are rare post-kidney transplantation, which might be life-threatening and usually need open surgical repair or even nephrectomy. EPSA combined with, or more precisely, caused by transplant renal artery stenosis is rare. There is still no consensus for the treatment of EPSAs. We report the diagnosis and spontaneous healing of an asymptomatic renal allograft EPSA caused by renal artery anastomotic stenosis, which was diagnosed in a timely manner and managed by conservative treatments. The stenosis was relieved after stent implantation, and the EPSA was cured spontaneously by completely filling with hypo-echoic thrombosis 8 mo after stenting.